AJMC October 2, 2020
The relatively few examples of commercially funded condition-specific bundled payments provide insights into how to spread this alternative payment model further in the private insurance market.
Am J Manag Care. 2020;26(10):In Press
Takeaway Points
Medicare has embraced condition-specific bundled payments (CSBPs) in its Bundled Payments for Care Improvement initiatives. However, commercial insurers have been slow to follow Medicare’s lead. In our critical appraisal of the few commercial CSBP programs, we highlight these primary takeaway points:
- Successful plans have closely aligned providers and payers who share data seamlessly.
- Conditions, entry, and end points must be clearly defined, but attempts to control all risk by using narrow or highly stratified entry criteria fail.
- Risk mitigation measures are necessary and most...
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Topics: Bundled Payments, CMS, Govt Agencies, Insurance, Payer, Payment Models, Provider, Value Based